Updated September 2, 2021
Notice ID: CMS210742
Award Number: 75FCMC21C0023
“The Maintenance of the Grouper contract ensures the accurate payment and uninterrupted processing of Medicare claims and is currently performed by 3M Health Information Systems (3M HIS) under a cost sharing contract arrangement (HHSM-500-2016-00048C). The period of performance for the current contract is 9/01/2016 through 8/31/2021. Although the contract is named Maintenance of the Grouper, it includes a variety of tasks that promote the systematic and uniform processing of Medicare claims that support Medicare payment policy analysis and development. For the purpose of this document, we will refer to this work as the Maintenance of the Grouper. The major functions in this contract are:
- Maintain and update software and editing programs and other supporting material for Medicare Severity Diagnosis Related Groups (MS-DRGs), the Medicare Code Editor (MCE), and the Integrated Outpatient Code Editor (IOCE);
- Provide analytical and programming support to CMS in maintaining, supporting and updating all of the groupers;
- Compute the MS-DRG relative payment weights used in the inpatient Prospective Payment System (PPS) and the Long Term Care Hospital PPS; and
- Evaluate CMS National Coverage Decisions (NCDs) that contain International Classification of Disease (ICD-10) codes for the appropriate updates.
- Conversion of the antiquated programming language (Assembler) to JAVA as part of the Medicare modernization effort…”
Posted March 24, 2021
Notice ID: CMS210742
“3M HIS contractor support is required to enable MACs to process and edit Medicare claims to ensure proper payment. As a result, continued 3M HIS contractor services are critical to the success of CMS’ billing, editing, and coding for the following reasons:
- Continuation of the planning and pre-development sources for all of the major payment programs listed above is required to ensure accurate payment and uninterrupted claims processing;
- Updates of the ICD-10-CM, ICD-10-PCS coding systems;
- Ensure changes to edits and logic for all of the above products required in response to multiple annual legislative mandates. This includes nonanticipated legislative mandates thus requiring analysis and implementation within a very short timeframe;
- Ensure the maintenance of the complicated MS-DRGs in ICD-10-CM as well as the ICD-10 PCS;
- Continue to optimize all Groupers with real time ICD-10 data; and
- Continue value added improvements and expansion of remotely accessible web based interfaces for the I/OCE, the Groupers, and MCE.”
“In addition, CMS is modernizing its grouping and code editor software. Medicare processes all Original Medicare institutional claims through one of three sub-systems within the Fiscal Intermediary Shared System (FISS). These sub-systems are built with an antiquated programming language (Assembler) that is difficult to extend, maintain, support and test. Modernizing these programs will protect CMS from future quality and integration risks. Currently, CMS posts these programs on its website as both COBOL source code and in a COBOL-based PC format. Over the next 2 years, CMS will convert these COBOL-based products to Java versions. 3M HIS is currently in Phase 3 of the six phases of conversion for these systems to Java versions.”
“As CMS programs have evolved, so has the complexity and scope of these software systems. Due to the unique nature of CMS requirements, 3M HIS is exclusively qualified to meet CMS’ need to continue to ensure the accurate editing and payment of Medicare claims.”
